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Globally, diabetes mellitus is considered to be an epidemic and a growing burden on public health (Matuleviciene, et al., 2014). It is associated with a significant morbidity and mortality (Schwartz & Scheiner, 2012). It has been estimated that 385 million people worldwide live with Diabetes and the number is predicted to rise to 500 million in 2030 (Matuleviciene, et al., 2014). In the UK, there are some four million people diagnosed with diabetes and an estimated additional 590,000 that are not yet diagnosed (Diabetes UK, 2015). The costs associated with diabetes account for almost 10% of the NHS primary care budget with a daily average expenditure of £2.2m on prescriptions for managing the condition (Matuleviciene, et al., 2014) (Lacobucci, 2014).
The key to good self-management of diabetes is to understand the importance of regular blood glucose measurement and the need for good blood glucose control together with a strong belief in one’s ability to achieve target levels. Levels of blood glucose vary dynamically from one individual to another and a recommended target range for blood glucose is determined by the healthcare team (Diabetes.co.uk, Blood Sugar Level Ranges). The target is individualised and based on the duration of diabetes, age, comorbid conditions, micro/ macrovascular diseases, hypo/ hyperglycaemia awareness and other individual considerations such as patient’s lifestyle and dietary habits (ADA, Checking Your Blood Glucose, 2015).
The American Diabetes Association suggests the blood glucose target in those with diabetes should be 4.4 to 7.2 mmol/L (80 to 130 mg/dL) before meals and under 9.0 mmol/L (162 mg/dL) for people with type 1 diabetes (T1DM) and under 8.5 mmol/L (153 mg/dL) for people with type 2 diabetes (T2DM) after meals (Diabetes.co.uk, Blood Sugar Level Ranges) (ADA, Checking Your Blood Glucose, 2015). These equate to glycated haemoglobin (HbA1c) levels of less than 7% or 48 mmol/L for people with diabetes (ADA, Checking Your Blood Glucose, 2015) (Diabetes.co.uk, Guide to HbA1c). The healthcare team can get an overall idea of the average blood glucose levels over a period of time –usually every three months- by regular measurement of HbA1c (Matuleviciene, et al., 2014) (Diabetes.co.uk, Guide to HbA1c). HbA1c is the gold standard marker for assessing long-term glycaemic control; however, it does not reveal the immediate hour-to-hour blood glucose levels like self-monitoring of blood glucose does and it does not provide detailed information about individual hyperglycaemic or hypoglycaemic excursions (Boutati & Raptis, 2009).